Noma : gangrenous stomatitis, water cancer, scorbutic cancer, gangrena oris, gangrene of the mouth / George H. Weaver and Ruth Tunnicliff.

  • George Howitt Weaver
Date:
[1907]
Catalogue details

Licence: In copyright

Credit: Noma : gangrenous stomatitis, water cancer, scorbutic cancer, gangrena oris, gangrene of the mouth / George H. Weaver and Ruth Tunnicliff. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    25 detached in fragments, and fall into the mouth, or are pulled off by the child without pain. Teeth and jaw-bones.—With the gangrenous destruction of the gums the teeth become loosened and fall out. The jaw, denuded of its periosteum, becomes necrotic to a corresponding extent. If life is sufficiently long preserved, or if recovery takes place, necrotic fragments of jaw may separate and be discharged. Such fragments may carry teeth with them. The necrosis may extend beyond the jaw-bone to the malar, temporal, and orbital bones. Salivatio?i.—There is usually a profuse flow of saliva, which early is sanguinated, and soon becomes black or brown with the gangrenous fragments in suspension. Odor.—The odor from the mouth is very offensive and characteristic. The breath is. usually fetid from the first few days, sometimes even before one notices a change in the buccal mucous membrane. It is often the first thing to excite atten- tion. Of itself the odor is not enough upon which to base a diagnosis, as pseudo- membranous stomatitis may emit a very similar odor. Henoch says that the odor is not only fetid, but gangrenous, and may not be detected readily. Skin and underlying tissues.—There may be an edematous swelling of the lips and cheek before the gangrene appears, which is like that observed in ulcerative stomatitis. This is usually present one or two days before the hard central swelling appears. Swelling of the submaxillary glands.—Taupin, quoted by Tourdes, observed an enlargement of the submaxillary glands in four cases out of 36. Boeckel and Con- stant also encountered it (Tourdes). Most of the earlier physicians have not men- tioned any glandular swelling. Barthez and Rilliet once found them enlarged to the size of pigeon’s eggs, grayish-red on section, soft, and filled with some fluid, but not suppurating. Bartels observed enlargement of the submaxillary glands in a woman of 40 and a child of three years. According to Bruns the lymph glands are not usually enlarged. Carriere-Montjosieu says the glands are not enlarged unless there is an added microbic infection. An enlargement of the submaxillary glands has been observed by later writers, as Henoch and Filatov. Pain.—Noma is generally described as a painless affection (Allbutt, Blumer and MacFarlane, Filatov, Gierke, Tourdes). According to Holt the pain is rarely severe; in many cases it is absent. Carriere-Montjosieu reports a case of noma in which pain was intense. Usually about the first to the third day of the gangrene there forms deep in the tissues a firm, hard, circumscribed kernel, 1-2 cm. in diameter. The overlying skin is then tense, shining as if oiled, often violet or marmolated. The hard kernel may not form until later, even on the sixth to the ninth day, and shortly before death. It was never absent in the cases observed by Barthez and Rilliet. Later it may soften because of gangrenous disintegration of the tissues entering into its formation. Accord- ing to Filatov: “In the beginning of the disease there always appears a tumor in the cheek, the integument being pale, not hot, and painless on pressure.” In many cases an eschar forms on the cheek. According to Baron it occurs on the second or third day. In Destries’ cases it occurred on the sixth day. Out of 21 cases observed by Barthez and Rilliet, it appeared between the third and seventh days in eight, on the 12th day in one, and on the 17th day in one. At the place where the eschar is to form the skin becomes violet and then black. Often a vesicle forms at the summit of the swelling of the cheek or lip, and soon it becomes
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